Dermatology consultations have demonstrated an ability to improve patient outcomes, reduce unnecessary utilization, and decrease clinical costs - and yet most community hospitals do not have sufficient access to dermatologists. Additionally, there is a long wait for primary care patients to see a dermatologist.
We partnered with experts from Penn Medicine’s Department of Dermatology to test the viability of teledermatology as a means to improve access to inpatient dermatology care. Utilizing the American Academy of Dermatology's AccessDerm program, we conducted a two-phase pilot study at Penn Presbyterian Medical Center and Pennsylvania Hospital.
The results of the pilot were published in The Journal of Telemedicine and Telecare in 2015.
The use of teledermatology in the inpatient setting proved feasible - with telemedicine alone sufficiently answering 40 percent of inpatient consultations. The intervention also reduced the time required for an attending dermatologist to respond to a consultation by approximately 16 minutes. The time for the primary team to receive the consultation response decreased by about 132 minutes - signaling that teledermatology could improve access to and efficiency of inpatient dermatology care.
Based on these findings, the team partnered with Independence Blue Cross to pilot outpatient teledermatology with a broader audience. In the more extensive study published in Telemedicine and e-Health, five primary care practices trained their providers to utilize a secure digital photography platform for teledermatology consults using a rotation of eight dermatologists. This workflow was used instead of the usual process of referring patients to the next available in-person dermatology appointment.
Dermatologists reviewed the pictures and then responded to the primary care physician with clinical recommendations, which included a triage determination of whether an in-person visit with a dermatologist was needed. The study's dermatologists completed these consultations within the course of their regular clinical duties without needing additional dedicated time to the effort. The response time for a consultation dropped from almost 84 days to under five hours. In addition, the study did not show any undue increases in utilization or cost that might be prohibitive to making the practice widespread.
The clinical team is currently working to establish a workable business model for teledermatology at Penn Medicine.